Re-Educating the Workers

Welsh comrades who refused to toe the Party line

In 1976, the Khmer Rouge, under the leadership of Pol Pot and the mysterious “Angkar” (the secret revolutionary leadership), took control of Cambodia. As with so many other despot regimes the intellectuals and the bourgeoisie where either exterminated or ‘re-educated’. Independent thought was anathema; wealth and status were irrelevant; families where broken up and displaced to farms or building projects; all in pursuit of the utopian society. It is estimated that between one and two million Cambodians (20% of the population) and some foreigners were tortured and executed throughout the 3 years, 8 months and 20 days of Khmer Rouge rule.

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The June edition of Ambulance UK appeared on station recently. This is the “see how wonderful we are” magazine for the Ambulance Services Association. On page 154 there’s an article about Alan Murray’s crackdown leadership of Welsh Ambulance Service. I’ve blogged previously about the mess WAS has got into (see here, here and here). Apparently he’s decided that tactics that were good enough for Stalin, Mao and Pol Pot are good enough for him…

“[Alan Murray] is on record as saying the service will meet the 60% response time target during 2007/08 – staff are being “educated” that the targets are clinically meaningful and and not just another governmental hoop through which they must jump.” (the emphasis is mine but the quotes around educated are as printed in the magazine)

Those who refuse to believe will be shot – or worse, made to work for NHS Re-Direct.

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This entry was posted on Sunday, July 15th, 2007 at 3:24 pm and is filed under ECP. You can follow any responses to this entry through the RSS 2.0 feed.
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Good to have you back. Interesting to note that in our service the role of Field Based Assessor is being replaced with the new “Clinical Team Educator”. I’m now seeing this change of title in a whole new light!

Do you have any snaps to show us from your trip? I for one would love to see some of the places you visited.

Also what’s with the spelling of Ambualcne in the Crippen quote? I know he makes the odd typo, but this is ridiculous.

Well I’m glad that you decided to be an ECP and not a judge. Condemned by one line in a journalistic summary.

Back in 1976, as a 24 year-old ambulanceman, I travelled from Belfast to Brighton to pay an unannounced visit to the great pioneer of paramedicine, Douglas Chamberlain. He treated me like a VIP, took me on his rounds and introduced me to some of his protégés. I had many memorable experiences on that trip, including working with a paramedic crew for the first time, but what sticks in my mind is something Douglas said to me. He said that paramedics should not be trained monkeys: they should understand the basis for what they do. He felt they should be educated as well as trained.

He bore no resemblance to Pol Pot then and, as I still have the privilege of working with him, I can confirm a continuing lack of resemblance.

In the intervening 31 years, paramedics have become much better educated in their clinical practice, communications and interpersonal skills. We’ve recently appointed some project management staff and they have just had a period of observation with EMS. They came back buzzing with excitement about the quality of health and human care demonstrated by their new colleagues.

However, precious few EMS staff have even a rudimentary understanding of the principles of EMS system design. Some don’t even seem to believe in a relationship between response time and good outcome in life threatening and serious emergencies.

When I talked about educating staff – all Trust staff and not just clinical staff – I was referring to my strong conviction, based on experience, that when embarking on a major change programme, education is a prerequisite to good communication. Education in what? Well, understanding the evidence underpinning the Government’s mandates would be a good start. Before 1996, we had the Orcon Standards; based on what English and Welsh ambulance services were thought capable of achieving and totally unconnected to clinical outcome. Meaningless, in other words.

In 1996, we commissioned a fundamental review of response standards which resulted in a number of innovations. Firstly, we acknowledged that all emergencies are not the same and set differential standards for life threatening and other emergencies. This has since evolved to the point where Category C emergencies can be treated entirely differently in a range of ways. Secondly, we redesigned our standards for life threatening emergencies based on good evidence such as Eisenberg M, Bergner L, Hallstrom A. Paramedic programs and out-of-hospital cardiac arrest: I. Factors associated with successful resuscitation. Am J Public Health. 1979 Jan;69(1):30–38. This and other evidence led to the adoption of the 8 minute standard for arrival of an ambulance, and RRV or an accredited alternative responder. The need for rapid transfer of major trauma and other types of high acuity patients led to the adoption of the population-density-banded 95th percentile standard for arrival of a transporting responder.

Of course, this is only reasonable if we are as accurate as it is possible to be when taking symptoms on a telephone in categorising our caseload; but you already know the strength of my views on that.

After that, it is important for staff to understand how we measure our effectiveness and efficiency, how our mandates translate into goals and the strategies we are adopting to achieve these goals.

Our educational effort began when we put all of this into an e-learning package. In the last few weeks, I’ve been travelling around Wales speaking to decent-sized groups of Trust staff and dealing again with these issues. Good grief, we’ve even been talking about patients and how all of this benefits them. Most of the staff who attended – however sceptical they were when they arrived – seem at worst to have appreciated the time and effort. Many have even commented positively.

If all it takes to be the moral equal of a genocidal dictator is a conviction that staff should know as much as their leadership then I must concede the argument.